The Children of Bolivia Overview Bolivia has made significant progress in recent years, but major challenges remain. Indicative of the progress, Bolivia is on-track to achieving many of its Millennium Development Goals (MDG) targets. For example, so far, the ones pertaining to extreme poverty, malnutrition, literacy, gender equality and institutional delivery coverage have already been reached.
However, Bolivia still has some of the worst social indicators in the region. Poverty rates remain high with 43 per cent of the country’s 10 million people living under the national poverty line of whom 61 per cent live in rural areas. Wide economic and social disparities persist especially between rural and urban areas, indigenous people and non-indigenous, poorer and richer groups and between females and males.
An indigenous boy in Tarabuco, Municipality, Chuquisaca. Incidence of extreme poverty (2012): 36.8 per cent among indigenous and 12.1 per cent among non-indigenous population groups
UNICEF/Bolivia/Pirozzi
Moreover, economic growth has been steady, averaging 4.8 per cent between 2008 and 2012, and now Bolivia is classified as a lower middle income country. The number of people in the middle-income group has grown from 2.1 to 5.3 million between 1999 and 2012, according to UNDP estimates. In addition, social expenditures in favour of children increased from 7.8 per cent to 8 per cent of Gross Domestic Product (GDP) between 2008 and 2010; that is from US$ 1.2 to 1.5 billion. The education sector receives the most at 64.2 per cent, whereas the health sector received 18.8 per cent and social protection 5.2 per cent.
The Children of Bolivia
WASH • Population using an improved water source: 88 per cent (95 per cent urban, 72 per cent rural) • Population with access to an improved sanitation system: 63 per cent (79 per cent urban, 32 per cent rural)
Key Indicators The country • Name of country: the Plurinational State of Bolivia • Capital: La Paz (administrative) • Largest city: Santa Cruz Population • Total population: 10.1 million • Indigenous population groups: 37 • Major languages: Spanish, Quechua, Aymara, Guarani Economic • Net international reserves:14.4 billion dollars in 2013 • Annual economic growth: 4.8 per cent between 2008 and 2012 • Exports: 12 billion dollars (2012) • Unemployment rate: 2.3 per cent (2012) Poverty • Extreme poverty reduced by 20 per cent between 1996 and 2012, reaching 21.6 per cent in 2012 • Extreme poverty is 3.4 times higher in rural areas than in urban areas • 28 per cent of children under 6 suffer from extreme poverty • 27 per cent of children between 6 and 17 suffer from extreme poverty • An estimated 2.3 million people were extremely poor (2012), of whom 1.5 million live in rural areas • Incidence of extreme poverty (2012): 36.8 per cent among indigenous and 12.1 per cent among non-indigenous population groups Education • Primary school net enrolment ratio: 82 per cent, with no difference between genders (2011); The rate fell from 94 per cent in 2002
• Completion rate for primary school: 90 per cent (2011) • Completion rate for secondary school level: 56 per cent • The gender gap in the primary completion rate improved substantially during the 1992-2011 period (from a difference in favour of men at 9.7 percentage points in 1992 to 1.2 percentage points in favour of women in 2011) • The literacy rate of the 15 year and over age group: 95 per centincreased from 80 per cent in 1992 and 87 per cent in 2001 • The literacy rate among the adolescents (15-18): 99 per cent Maternal and Child Health • Infant mortality rate: 49 per 1,000 live births (2011); reduced from 82 in 1989 • Neonatal mortality: 27 per 1,000 live births between 2003 and 2008 • The maternal mortality ratio: 229 maternal deaths per 100,000 live births (Most recent data recognized by the GoB, 2003) • Births attended in health facilities: 67 per cent; increased from 53 per cent in 2001 • Adolescent mothers between 15 and 18 years: 9 per cent; reduced from 10 per cent in 2001 • Immunization of children under 1 with third dose of pentavalent vaccine: 80 per cent in 2012 (target set for 2015 is 95 per cent) HIV/AIDS • The incidence of HIV: 212 persons per million inhabitants in 2012 (83 persons per million inhabitants for AIDS), a rate 20 times higher than in 2000 (6 times for AIDS); an average annual rate of 35 per cent (20 per cent for AIDS) • Antiretroviral therapy use increase (annual average): 68 per cent in the last four years
Nutrition • Chronic malnutrition among children under-3 reduced from 42 out of 100 in 1989 to 18 out of 100 in 2012 • The probability a child under-3 suffers from chronic malnutrition is 1.8 times higher in rural areas (25.9 per cent), rather than in urban areas (14.6 per cent) • Prevalence of chronic malnutrition in children under three exhibits a gap of 26 percentage points between the poorest group and higher income group Child Protection • Children between 5 and 13 involved in some form of labour activities: 11 per cent • Working children who participate in domestic labour: 83 per cent girls and 77 per cent boys • Registered population: 97 per cent; increased from 90 per cent in 2001 • Children under 5 who are registered: 87 per cent • Female adolescents and youth who are married or in some kind of union who suffered violence by a partner: 48 per cent • Children who suffered violent discipline in households: an estimated 80 per cent • The trafficking rate per 100,000 population: 3.1 reported cases and 4.4 in 2012, higher than any other country in the region; (0.5 in Argentina and Peru, 0.1 in Chile and Colombia). The rate of rape: 15.2 cases per 100,000 inhabitants in 2005 increased to 24.5 in 2009 and 40.9 in 2012, according to the national police • Family violence rates: 458 per 100,000 inhabitants in 2005, increased to 478 in 2009 and up to 580 in 2012 (national police records)
Sources used: Séptimo Informe de Progreso de los Objetivos de Desarrollo del Milenio en Bolivia UDAPE, 2013; UDAPE Estimations; Estudio global de pobreza y disparidades de la niñez UNICEF UDAPE 2010.
Calle 20, 7720, Calacoto, La Paz, Bolivia / Phone (591-2) 2770222 Fax (591-2) 2772101 / lapaz@unicef.org / www.unicef.org/bolivia
Health
Issue There has been significant progress towards healthrelated Millennium Development Goals, but Bolivia still has more inequities in health than any other country in the Americas.
Neonatal mortality is high, remaining static at 27 per 1,000 live births between 2003 and 2008. There is a need for more effective interventions during pregnancy, birth and the infant’s first month of life. Tackling anaemia in pregnant and breastfeeding women is also a challenge. Anaemia in pregnant women can lead to serious complications, such as preterm delivery, and in infants it can lead to irreversible development and behaviour problems.
A medical unit arrives to Alianza community, close to Minero town in the Department of Santa Cruz, to visit the Angulo Urquizo family. Their youngest member Marcelo is 22 months old, he was malnourished and went through a treatment at the hospital and now he is back at home.
UNICEF/Bolivia/Pirozzi
Reducing maternal and neonatal deaths is a priority. Indigenous women in rural areas are four times more likely to die due to complicated pregnancy, delivery and post-partum-related causes than women living in urban areas. They tend to be poorer, live far away from health services, have less access to information and are more likely to be uneducated.
Health Key Indicators • Under-five infant mortality rate: 63 per 1,000 live births; • Neonatal mortality rate: 27 per 1,000 live births; • Neonatal mortality represents 54 per cent of infant mortality, of which 75; per cent occur during the first week after birth; • Immunization coverage with third dose of pentavalent vaccine in <1 year: 79.7 per cent; • Maternal mortality ratio: 229 per 100,000 live births; • Adolescent pregnancies: 9 per cent of female adolescents between 15 and 18 were already mothers; • Births attended by skilled personnel:70.8.
TM Infant Source:
Source:
and
and
Sources used: National Demographic and Health Survey (ENDSA 2008); Séptimo Informe de Progreso de los Objetivos de Desarrollo del Milenio en Bolivia, UDAPE 2013.
Calle 20, 7720, Calacoto, La Paz, Bolivia / Phone (591-2) 2770222 Fax (591-2) 2772101 / lapaz@unicef.org / www.unicef.org/bolivia
HIV and AIDS
Issue
Moreover, although there has been notable progress in preventing vertical transmission of HIV from mothers to their infants, clinical and laboratory follow up of HIV positive children remains a major challenge.
Hospital 18 de Marzo, Santa Cruz de la Sierra city, oďŹ&#x20AC;ers tests to prevent vertical transmission of HIV from mothers to their infant. Clinical and laboratory follow up of HIV positive children remains a major challenge.
UNICEF/Bolivia/Duranboger
Bolivia has made significant progress towards achieving the Millennium Development Goals related to HIV and AIDS. However, as HIV and AIDS in Bolivia is defined as a concentrated epidemic among high risk groups, such as men who have sex with men, and sex workers, HIV interventions have been limited. Culturally-sensitive interventions have not yet been successfully scaled up to reach all vulnerable groups, such as young people in remote indigenous communities.
HIV and AIDS Key Indicators • Adult (aged 15-49) HIV prevalence rate: estimated at 0.15 per cent; • AIDS prevalence (per 1’000’000): 83.4 (2012); • Number of reported HIV cases: 9,296 cases of whom 20 per cent were diagnosed with AIDS (December 2012); • The population group aged 15-24 years with proper knowledge on HIV: 22.4 per cent girls/women, 27.7 per cent boys/men; • Geographical spread of HIV: 90 per cent of HIV cases are reported from the three departments of Cochabamba, Santa Cruz and La Paz; • Pregnant women tested with HIV rapid test in 2013; 68 per cent of whom 200 tested positive, and 94 per cent received antiretroviral therapy (ART); • Children who were reported HIV positive from 1984 to June 2014: 198 children (National HIV/AIDS Programme); • The number of HIV positive children who are being followed up:128 children and 115 of them are receiving antiretroviral therapy (National HIV/AIDS Programme); • Percentage of children who are not receiving medical follow up and care: 35 per cent (National HIV/AIDS Programme) using an improved source of water: 87 per cent (95 per cent urban, 72 per cent rural); • Population with access to an improved sanitation system: 63 per cent (79 per cent urban, 32 per cent rural).
Sources used: Plan Nacional ITS/VIH/SIDA, 2013; Séptimo Informe de Progreso de los Objetivos de Desarrollo del Milenio en Bolivia, UDAPE 2013; DHS 2008 (ENDSA).
Calle 20, 7720, Calacoto, La Paz, Bolivia / Phone (591-2) 2770222 Fax (591-2) 2772101 / lapaz@unicef.org / www.unicef.org/bolivia
Nutrition Issue Reducing chronic malnutrition among children in rural areas remains a major challenge for Bolivia. The probability that a child under the age of three suffers from malnutrition is 1.8 times higher in rural areas (25.9 per cent) than in urban areas (14.6 per cent).
The reasons for widespread child malnutrition in Bolivia are complex and varied. Generally children become malnourished due to chronic nutritional deficiency which is often worsened by disease. This can begin before birth if their mothers were poorly nourished during pregnancy. Other causes include lack of good breastfeeding and infant feeding practices. Many women in Bolivia do not practice early initiation and exclusive breastfeeding for the first six months. Mothers introduce solids too early and childrenâ&#x20AC;&#x2122;s diets tend not to be well-balanced, age-appropriate and lack vital micronutrient and vitamin supplements. In addition, families, particularly in rural areas, lack access to safe water, as well as good hygiene and sanitation in the home which is critical to prevent diarrhoea and other illnesses that deplete the child of essential nutrients.
Juana Sucubono a mother from Ignacio de Moxos, Beni, breastfeeds her six month old baby girl and complements with banana and vegetables puree.
UNICEF/Bolivia/Abramsom
Pregnant women, lactating mothers and children under the age of three must be targeted with interventions to prevent and treat malnutrition. Interventions are especially important during the first 1,000 days of a childâ&#x20AC;&#x2122;s life â&#x20AC;&#x201C; the critical window of opportunity. If a malnourished child is left untreated during that time and survives beyond the age of three years, they can suffer irreversible stunting, which will impede both their cognitive and physical development.
Nutrition Key Indicators • Children under three years suffering from chronic malnutrition: 18.5 per cent; • Children under three years suffering from chronic malnutrition in rural areas: 25.9 per cent; • Chronic malnutrition prevalence gap between the richest and poorest quintile : 26 percentage points; • Chronic malnutrition in the most affected Departments: Potosí (42.5 per cent), Oruro (35.3 per cent) and in Chuquisaca (34.1 per cent).
Sources used: Séptimo Informe de Progreso de los Objetivos de Desarrollo del Milenio en Bolivia, UDAPE 2013
Sources used: Séptimo Informe de Progreso de los Objetivos de Desarrollo del Milenio en Bolivia, UDAPE 2013
Calle 20, 7720, Calacoto, La Paz, Bolivia / Phone (591-2) 2770222 Fax (591-2) 2772101 / lapaz@unicef.org / www.unicef.org/bolivia
Education Issue Bolivia has significantly improved access to quality primary education, but challenges remain particularly increasing access to early childhood education, improving learning outcomes and reducing educational disparities. For example, a non-indigenous boy in an urban area belonging to the highest income quintile completes on average 14.4 years of schooling, whereas an indigenous girl in a rural area belonging to the lowest income quintile completes only two years of schooling. Children in remote indigenous communities have many educational barriers to overcome. Most have long and difficult journeys to school especially once they reach secondary level.They can trek for up to two-hours across harsh mountainous terrain or through dense forests. For children in the Amazon rainforest, they usually need to take a boat too. These journeys can be hazardous particularly during the rainy season as mountain slopes are slippery and the Amazon area is prone to floods. Moreover, the long walks leave children, particularly adolescent girls, vulnerable to abuse.
For children who continue with their schooling, the quality of education in rural areas is low. Community school teachers have to teach all the children together in one class up to grade three. Teachers are usually not trained to do this and many do not understand the local language which is meant to be taught alongside Spanish. Most school buildings are poorly constructed or maintained and lack basic facilities, including running water and electricity.
A Yampara indigenous girl during a class at Pisili School, Tarabuco Municipality, Chuquisaca.
UNICEF/Bolivia/Pirozzi
Many parents in rural areas, who tend to be extremely poor and uneducated, consider the distances as well as the costs for school materials, and decide it is better to keep their older children at home so that they can work, for example on family farms, plantations and in the mines.
Education Key Indicators Early childhood development education • Percentage of children who have access to early child development education: an estimated 3 per cent of children; rural areas are the most excluded.
Basic education
• Percentage of school-age children who are out of school: 18 per cent; • Pupils who complete secondary level: 56 per cent.
Quality education
• Learning outcomes: 18 per cent of grade 5 students have a high level of reading comprehension and 15 per cent have a high level of logical-mathematical reasoning skills, especially for early grades; • Regionalized curricula elaborated for indigenous nations: 7/37; • Number of children who had their education interrupted during the flood emergency of 2014: 63,022.
Sources used: Registro Único de Estudiantes - Ministerio de Educación 2011; Global Initiative Children Out of School UNICEF 2012; SIE-Ministerio de Educación 2012; OPCE-Ministerio de educación 2011.
Calle 20, 7720, Calacoto, La Paz, Bolivia / Phone (591-2) 2770222 Fax (591-2) 2772101 / lapaz@unicef.org / www.unicef.org/bolivia
Child Protection Issue The Government of Bolivia has made significant efforts to prevent violence against children and women, and to reduce child labour and human trafficking. In addition, the government has harmonized the Child and Adolescent Act with the Political Constitution of the State and international standards; for instance, corporal punishment is now prohibited in the home.
Therefore, interventions to tackle violence against children need to be urgently stepped up; so far they have been too slow, too uneven and too fragmented. Most Bolivian girls and boys who are exposed to violence still live in isolation, loneliness, and fear. Many children simply do not know where to turn for help, especially when the perpetrator is a family member, caregiver, teacher or anyone else responsible for their protection and well-being. Many parts of the country lack child protection services or if they exist, the quality of service is poor. For example, only one out of the country’s nine departments has an intervention
The Centro de Atención Terapéutica (CEPAT) in the town of Potosí, offers therapeutic and psychological support to children victims of sexual abuse.
UNICEF/Bolivia/Pirozzi
However, high levels of violence are still a major concern, particularly domestic violence and violence in schools. In 2008, 80 per cent of households used corporal punishment on children; 50 per cent of children engaged in bullying as victims, aggressors or witnesses; and 60 per cent of students were victims of violence perpetrated by their teachers. Women and adolescent girls remain the main victims of violence. In 2008, 38 per cent of female partners were victims of physical, sexual and/or psychological violence in the home.
Child Protection for alternative measures to the deprivation of liberty for adolescents who come in conflict with the law. Regarding the right to an identity, Bolivia is still one of the countries that has a low rate of timely birth registration for children under one and five years of age. The lowest rates are among populations living in rural areas or in the rainforest in the Amazonian departments. Child labour is also still a major challenge. According to the last child labour survey in 2008, nearly 800,000 children and adolescents were engaged in some form of labour. The new Child and Adolescent Act has included two new worrying exceptions for child labour that allow children to work at the age of 10 and 12. Although the Act says that children allowed to work under these exceptions should be regulated and closely monitored, the existing child protection system is too weak to do so effectively. Moreover, despite the fact that children are prohibited to engage in the worst forms of child labour, still about 400,000 children work under these conditions, for example down mines and on sugar cane plantations.
Key Indicators • Children under the age of 5 who are registered: 87 per cent; • Children between the ages of 5 and 13 who are involved in some form of labour: 11 per cent; • Working children who participate in domestic labour: 83 per cent girls and 77 per cent boys; • Trafficking rate per 100,000 population: 3.1 reported cases, higher than any other country in the region; (0.5 in Argentina and Peru, 0.1 in Chile and Colombia); • Rate of reported rape: 15.2 cases per 100,000 inhabitants in 2005 increased to 24.5 in 2009 and 40.9 in 2012 (national police records); • Family violence rates: 458 per 100,000 inhabitants in 2005, increased to 478 in 2009 and up to 580 in 2012 (national police records); • Children who suffer violent discipline at home: approximately 80 per cent.
Sources used: Census data 2012; National Survey on Child Labour 2008; UNDP Report on Public Safety published, 2009; DHS 2008 (ENDSA); national police records.
Calle 20, 7720, Calacoto, La Paz, Bolivia / Phone (591-2) 2770222 Fax (591-2) 2772101 / lapaz@unicef.org / www.unicef.org/bolivia
Social Inclusion
Issue
Although there has been significant progress, Boliviaâ&#x20AC;&#x2122;s social indicators are still among the worst in the region and huge disparities persist. Of the countryâ&#x20AC;&#x2122;s 3.8 million children and adolescents, about 1.0 million are disadvantaged by lack of income, inequality and social exclusion. Most of these children and adolescents are from indigenous rural communities. They often live far from schools, are more likely to engage in child labour, face discrimination and suffer other kinds of abuse and disadvantage. Girls are particularly marginalized. The poorest adolescent girls are more likely to be adolescent mothers and subsequently miss out on a proper education and other opportunities. Moreover, they are also more susceptible to maternal mortality, morbidity and under nutrition. Data collection needs to be improved for evidencebased advocacy and to assist with the design of cost effective policy interventions in favour of the most excluded children.
A couple of adolescent brothers at Santa Rosa community, Monteagudo, Chuquisaca. Of the countryâ&#x20AC;&#x2122;s 3.8 million children and adolescents, about 1.0 million are disadvantaged by lack of income, inequality and social exclusion.
UNICEF/Bolivia/Pirozzi
Economic, social, political, cultural and institutional changes over the past 10 years have shone light and cast shadows over the rights of Bolivian children and adolescents.
Social Inclusion Key Indicators • Population considered poor: approximately 4.3 million people; about 43 per cent of the total population • People in rural areas who lack sufficient resources to buy a basic food basket: 61 per cent • The incidence of extreme poverty in indigenous population (36.8 per cent) is three times higher than the non-indigenous one (12.1 per cent) • Children and adolescents who are income poor: 27 per cent of children and adolescents - approximately 1.0 million people • Children and adolescents who are considered poor from a multidimensional perspective; deprived in at least two of the seven dimensions of poverty defined by UNICEF: 58 per cent in 2007
Sources used: Séptimo Informe de Progreso de los Objetivos de Desarrollo del Milenio en Bolivia UDAPE, 2013; UDAPE estimations; Estudio global de pobreza y disparidades de la niñez, UNICEF UDAPE 2010.
Source: Séptimo Informe de Progreso de los Objetivos de Desarrollo del Milenio en Bolivia UDAPE, 2013.
Source: Séptimo Informe de Progreso de los Objetivos de Desarrollo del Milenio en Bolivia UDAPE and INE, 2013.
Calle 20, 7720, Calacoto, La Paz, Bolivia / Phone (591-2) 2770222 Fax (591-2) 2772101 / lapaz@unicef.org / www.unicef.org/bolivia
Water, Sanitation and Hygiene
Issue
Waterborne diseases like diarrhoea and poor hygiene practices threaten the lives and health of young children. Diarrohrea is one of the leading causes of preventable illnesses and deaths in children under 5 in Bolivia. Poor sanitation also contributes to children missing out on their education, particularly girls, as many schools lack toilets and handwashing facilities. Menstrual hygiene is a particular challenge for adolescent girls attending schools with no sanitation and handwashing facilities, supplies or opportune information.
â&#x20AC;&#x153;At the school we have latrines and showers heated by solar panels. The teacher taught us how to wash our hands, how to get a shower and use the latrine, all important of my personal and family hygieneâ&#x20AC;?, says Lizbeth Vela, who attends molle mayu school located at Icla municipality in the Chuquisaca department.
UNICEF/Bolivia/Pirozzi
Bolivia has met the Millennium Development Goal target relating to access to water, but access to sanitation and good hygiene practices lag behind with a wide gap between urban and rural populations.
Water, Sanitation and Hygiene Key Indicators • Populaton using an improved source of water: 87 per cent (95 per cent urban, 72 per cent rural); • Population with access to an improved sanitation system: 63 per cent (79 per cent urban, 32 per cent rural).
Sources used: Séptimo Informe de Progreso de los de Objetivos Desarrollo Milenio, UDAPE 2013.
Calle 20, 7720, Calacoto, La Paz, Bolivia / Phone (591-2) 2770222 Fax (591-2) 2772101 / lapaz@unicef.org / www.unicef.org/bolivia